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Spinal Cord Tumor 

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What is it?
Spinal cord tumors are abnormal growths of tissue found in or near the spinal cord causing pressure on sensitive tissues or impairing nerve function. Most spinal cord tumors form below the neck.

Tumors of the spinal cord can be classified by their location within the spinal canal or by their cell type. When classified by their location, the tumor may be described as extradural, intradural, medulla, extramedullary and intramedullary. When tumors are classified by cell type they may be described as metastatic, meningioma, neurofibroma, lymphoma, ependymoma or astrocytoma.

What are the symptoms?
Some symptoms of spinal tumors are due to the compression of the spinal cord. They may come on gradually, and include:

-- Motor problems
Including muscle weakness, spasticity, impaired bladder and/or bowel control; could develop into muscle wasting, paralysis and ataxia (abnormal walking rhythm).

-- Pain
May be severe and is often constant; may have a burning or aching quality.

-- Sensory changes
Numbness and decreased skin sensitivity to temperature changes.

Generally speaking, symptoms affect the body at or below the level of the tumor. For instance, a tumor midway along the spinal cord (thoracic spine) may cause pain throughout the chest area; a tumor located in the top fourth of the spinal column (cervical spine) may cause pain in the neck and arms; a tumor in the lower (lumbar spine) area can cause leg or back pain.

How is a spinal cord tumor diagnosed?
The most critical first step in diagnosing a spinal cord tumor is an accurate history and physical examination to help quickly pinpoint the affected area. This will include the testing of such functions as: motor, sensory reflexes, and reflexes of the arms and legs as well as balance and gait.

If your doctor thinks a brain problem may be present, he or she will likely order one or more imaging tests. These tests include CT scans or MRI. Magnetic resonance spectroscopy, which is like an MRI, except that the radio waves interact with different atoms within the tissues, so the images may highlight some features of tumors that are not clearly seen by MRI.

Positron emission tomography (PET) scan, which can provide a picture of abnormal areas, may be used.

A lumbar puncture or “spinal tap” may be used to obtain a sample of spinal fluid for testing. This process is more commonly used with an intraspinal dye injection called a myelogram, to test for spinal tumors.

A chest X-ray and angiogram, another imaging test, may be ordered.

Doctors may also use results of a biopsy to diagnose whether a tumor is benign or malignant (cancerous) and exactly what type of tumor is present.

How is a spinal cord tumor treated?
Several types of treatment may be used to treat central nervous system tumors, including surgery, radiation therapy, chemotherapy and other types of drugs. Treatment is different for different kinds of tumors, and in many cases a combination of treatments is used. The effectiveness of treatment depends on a number of factors including the type, size and location of the tumor.

Surgical
Surgery is the treatment of choice for intradural and extramedullary tumors. Malignant, partially resected or inoperable tumors may be treated with radiation therapy or chemotherapy, or both.

Microsurgery is any surgery performed with the assistance of a microscope. It has improved several standard neurosurgical procedures, such as the removal of certain spinal tumors, and has allowed for the removal of some tumors that previously were inaccessible or dangerous to remove.

Other Treatments
Stereotactic radiosurgery may be appropriate for patients who may also benefit from radiation, either conventional or focused, such as “CyberKnife,” which delivers image-guided radiation to treat cancerous and begin tumors and abnormal tangles of blood vessels. This technology allows the surgeon to pinpoint a target with greater accuracy than ever before using three-dimensional coordinates and special instrumentation for spinal fusions and to remove small tumors.

Read more about the Sentara Advanced Radiosurgery Center and CyberKnife.

Ultrasonic aspiration can be used to help break up and remove the tumor.

Steroids control the swelling due to accumulation of fluids associated with spinal tumors. They may be administered temporarily following surgery or during radiation to reduce edema, or they may be used long-term for relief of symptoms.

Chemotherapy uses special chemicals to poison tumor cells, which are more vulnerable to chemicals than healthy cells. It may be used before, during or after surgery and radiation therapy. Dozens of new chemotherapeutic drugs are being studied and tested to determine their effectiveness in improving survival and recovery. If you meet the criteria for a clinical trial, your physician can offer you the option of participating in the research.

Radiation is often used as follow-up after surgery to eliminate remaining tumor cells, or may be used to treat tumors that cannot be operated upon. Because many tumors are radio-sensitive, their cells die when exposed to radiation.

What research is being done?
There is a great deal of ongoing research in the United States involving better and more effective treatments for spinal cord tumors. Promising areas of research include gene therapy, immunotherapy research and use of monoclonal antibodies (multiple copies of a single antibody) to pinpoint and destroy specific tumor cells.

For the latest on research on spinal cord tumors visit these Web sites:

-- The National Institute of Neurological Disorders and Stroke
-- American Cancer Society

Can spinal cord tumors be prevented?
Scientists do not know what causes most primary spinal cord tumors. Viruses, defective genes and certain chemicals are all being explored and researched as possible culprits, but until the causes have been identified there is no known way to prevent developing a spinal cord tumor.

Sources
-- The American Cancer Society
-- The National Institute of Neurological Disorders and Stroke


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